March 2nd, 2016

     Silk Road Development made a commitment in 2010 to direct attention and priority to Afghans that had slipped through the healthcare "safety net". The terminally ill have always been among the most difficult to care for in all cultures. Unfortunately, Afghanistan has had limited resources to deliver chemotherapy and radiation treatment to cancer patients and as of yet, there is no public health policy toward palliative care for those with incurable disease and organ failure.

     Hamdardi (translated from Dari; empathy, compassion, sharing suffering), Silk Road's plan for home hospice care to the terminally ill, became a reality in May 2010 after 2 years of planning and cooperation with the MOPH (Afghanistan's Ministry of Public Health). The concepts of palliative care, and in particular hospice required thoughtful strategy to allow implementation in a country where all out, expensive efforts to save lives exceeding realistic possibility of cure was the norm.

     Through the leadership of an equally wise and compassionate Afghan health professional, who served as clinical coordinator and initial home caregiver, Hamdardi began with a one-year pilot program between 2010-2011 in the Dashte Barchi area of Kabul. Fourteen patients received care with post-treatment careful surveying of acceptability, impact and respect for cultural and religious values. The results were overwhelming. Patients, families, neighborhoods and religious leaders conveyed deep appreciation and acceptance of the home visits and personalized care by Hamdardi caregivers. The pilot project was reviewed by the MOPH and the Consultative Group for Health and Nutrition (CGHN), the latter tasked with approving all healthcare endeavors in Afghanistan in 2012. Silk Road Development was given enthusiastic support to continue and expand Hamdardi.

     Over the last 5 years, more than 115 patients have been cared for in the home by Hamdardi during the last 6-12 months of life. All were suffering, most families were confused and unable to completely care for their loved ones. The majority was risking financial ruin pursuing hopeless medical and surgical treatment. Hamdardi reset the agenda for these patients. More appropriate goals of care were established, taught and full grasped. These goals included relief of pain, better nutrition, immaculate wound care and teaching families how to care for and anticipate the eventual end of life stages. Not a single family has been charged a fee for service as Silk Road Development supporters have funded all care.

     The proof of positive impact continues to be in the wonderful relationships built between Hamdardi caregivers and patients, families and extended community and religious leaders. One of the visible outcomes has been the growing number of volunteer Hamdardi caregivers coming from the family members of patients who were under our care. They have been taught and encouraged to give to others the same compassionate care their loved one received from Hamdardi.

     Hamdardi is not like hospice care anywhere else in the world. It is Afghan in leadership, style and custom. Medical expertise is supported first by Afghan physicians in the community and local hospitals. Tertiary consultation, funding and continuing education is further provided by supporters outside of Afghanistan through Silk Road Development. Initial care was localized to the Dashte Barchi area of Kabul, and has now expanded to the greater Kabul area. The MOPH has encouraged further provision to other areas and Silk Road Development's long-range goals are to initiate Hamdardi to other cities. The ultimate task is for palliative and hospice care to be included in the Basic Package for Healthcare Services (BPHS) offered nationwide by the MOPH. Silk Road Development hopes to establish a good, reproducible model that will be adopted by government and private healthcare deliverers.

     Compassion and touch are universally beautiful human qualities. This is particularly true when there is no hope. Hamdardi gives hope to patients whose days are filled with pain and to families that are frustrated, confused and grieving. It is free only to the recipients, thus Silk Road Development is seeking partners who understand this God-given need for hope. Please consider how you may help, financially and professionally. All funds given to Hamdardi go directly to the delivery of patient care and financial support of our clinical coordinator and caregivers. We hope your heart will be touched by the many who have no other direction to turn toward for relief of suffering. 

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